Background: Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. Methods: In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. Results: Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. Conclusion: Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.

Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients : A retrospective multicenter study / S. Rausei, L. Ruspi, F. Rosa, P. Morgagni, D. Marrelli, A. Cossu, F.C.M. Cananzi, R. Lomonaco, A. Coniglio, A. Biondi, C. Cipollari, L. Graziosi, U. Fumagalli, F. Casella, P. Bertoli, A. di Leo, S. Alfieri, G. Vittimberga, F. Roviello, E. Orsenigo, V. Quagliuolo, S. Montemurro, G. Baiocchi, R. Persiani, M. Bencivenga, A. Donini, R. Rosati, A. Sansonetti, L. Ansaloni, A. Zanoni, F. Galli, G. Dionigi. - In: EUROPEAN JOURNAL OF SURGICAL ONCOLOGY. - ISSN 0748-7983. - 42:12(2016), pp. 1881-1889. [10.1016/j.ejso.2016.05.003]

Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients : A retrospective multicenter study

G. Dionigi
2016

Abstract

Background: Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. Methods: In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. Results: Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. Conclusion: Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.
Elderly; Gastric cancer; High morbidity; Lymphadenectomy; Tailored treatment; Adenocarcinoma; Adult; Age Factors; Aged; 80 and over; Cardiovascular Diseases; Comorbidity; Dementia; Diabetes Mellitus; Disease-Free Survival; Female; Gastrectomy; Humans; Liver Diseases; Lymph Node Excision; Male; Middle Aged; Postoperative Complications; Pulmonary Disease; Chronic Obstructive; Retrospective Studies; Stomach Neoplasms; Survival Rate; Surgery; Oncology
Settore MED/18 - Chirurgia Generale
Article (author)
File in questo prodotto:
File Dimensione Formato  
1-s2.0-S0748798316301536-main.pdf

accesso riservato

Tipologia: Publisher's version/PDF
Dimensione 910.64 kB
Formato Adobe PDF
910.64 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/877110
Citazioni
  • ???jsp.display-item.citation.pmc??? 8
  • Scopus 26
  • ???jsp.display-item.citation.isi??? 25
social impact